Comparative results of open lower extremity revascularization in nonagenarians

Hnath, Jeffrey; Roddy, Sean P.; Darling, R. Clement; Paty, Philip S.K.; Taggert, John B.; Mehta, Manish

doi:10.1016/j.jvs.2009.02.012

Cited by 12 publications

(14 citation statements)

References 9 publications

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“…However, determining which factors are most important when deciding an intervention is the key issue because there are historical reports of good outcomes for infrainguinal revascularization in medically high-risk patients. 18 Patients often have multiple atherosclerotic risk factors and extensive coronary disease that stratify them into a high-risk cohort for conventional open infrainguinal arterial reconstruction. 19 Multiple series have identified diabetes, age >80 years, and renal failure as independent physiologic predictors of bad outcomes for both endovascular and open surgical revascularization.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of open and endovascular revascularization of superficial femoral artery occlusive disease

Scali

Rzucidlo

Bjerke

et al. 2011

Journal of Vascular Surgery

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Background First-line treatment for patients with superficial femoral arterial (SFA) occlusive disease has yet to be determined. This study compared long-term outcomes between primary SFA stent placement and primary femoral-popliteal bypass. Periprocedural patient factors were examined to determine their effect on these results. Methods All femoral-popliteal bypasses and SFA interventions performed in consecutive patients with symptoms Rutherford 3 to 6 between 2001 and 2008 were reviewed. Time-dependent outcomes were analyzed using the Kaplan-Meier method and log-rank test. Cox proportional hazards were performed to determine predictors of graft patency. Multivariate analysis was completed to identify patient covariates most often associated with the primary therapy. Results A total of 152 limbs in 141 patients (66% male; mean age, 66 ± 22 years) underwent femoral-popliteal bypass, and 233 limbs in 204 patients (49% male; mean age, 70 ± 11 years) underwent SFA interventions. Four-year primary, primary-assisted, and secondary patency rates were 69%, 78%, and 83%, respectively, for bypass patients and 66%, 91%, and 95%, respectively, for SFA interventions. Six-year limb salvage was 80% for bypass vs 92% for stenting (P = .04). Critical limb ischemia (CLI) and renal insufficiency were predictors of bypass failure. Claudication was a predictor of success for SFA stenting. Three-year limb salvage rates for CLI patients undergoing surgery and SFA stenting were 83%. Amputation-free survival at 3 years for CLI patients was 55% for bypass and 59% for SFA interventions. Multivariate predictors (odds ratios and 95% confidence intervals) of covariates most frequently associated with first-line SFA stenting were TransAtlantic Inter-Society Consensus II A and B lesions (5.9 [3.4-9.1], P < .001), age >70 years (2.1 [1.4-3.1], P< .001), and claudication (1.7 [1.1-2.7], P= .01). Regarding bypass as first-line therapy, claudicant patients were more likely to have nondiabetic status (5.6 [3.3-9.4], P < .001), creatinine <1.8 mg/dL (4.6 [1.5-14.9], P = .01), age <70 years (2.7 [CI, 1.6-8.3], P < .001), and presence of an above-knee popliteal artery target vessel (1.9 [CI, 1.1-3.4] P = .02). Conclusion Indication, patient-specific covariates, and anatomic lesion classification have significant association when determining surgeon selection of SFA stenting or femoral-popliteal bypass as first-line therapy. Patients with SFA disease can have comparable long-term results when treatment options are well matched to patient-specific and anatomic characteristics. (J Vasc Surg 2011;54:714-21.)

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Section: Discussionmentioning

confidence: 99%

Long-term results of open and endovascular revascularization of superficial femoral artery occlusive disease

Scali

Rzucidlo

Bjerke

et al. 2011

Journal of Vascular Surgery

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“…Several papers have reported outcomes of one vascular treatment comparing younger patients with an older cohort [22][23][24]. However, we are not aware of another paper that has reported on such a large number of patients over such a long time, describing all the common open and endovascular procedures, thus effectively reflecting our total experience in arterial surgery over the past 30 years.…”

Section: Discussionmentioning

confidence: 99%

An analysis of vascular surgery in elderly patients to determine whether age affects treatment strategy

et al. 2011

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A paradigm shift has occurred towards endovascular management of aortic, iliac and femoral arterial disease. Whilst patient age >75 significantly impacts on complication rates from index open vascular procedures, age does not impact upon complication rates of corresponding endovascular procedures. We, therefore, recommend an endovascular approach be adopted as first line for all patients, regardless of patient age.

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“…Age alone, however, is not a contraindication for arterial reconstruction. 55,56 Patients with terminal cancer with a very short life expectancy or similar lethal comorbidities do poorly with open revascularization and are probably better served by endovascular intervention or primary amputation. Patients with an unsalvageable foot due to extensive necrosis from ischemia or infection also require primary amputation.…”

Section: Treatment Selectionmentioning

confidence: 99%

Management of diabetic foot problems

Kalish

Hamdan

2010

Journal of Vascular Surgery

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Comparative results of open lower extremity revascularization in nonagenarians

Abstract: Lower extremity bypass for nonagenarians offers acceptable patency and limb salvage but at a significantly higher mortality rate.

Cited by 12 publications

References 9 publications

Long-term results of open and endovascular revascularization of superficial femoral artery occlusive disease

Long-term results of open and endovascular revascularization of superficial femoral artery occlusive disease

An analysis of vascular surgery in elderly patients to determine whether age affects treatment strategy

Management of diabetic foot problems

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